多西紫杉醇联合卡铂治疗老年子宫内膜癌的疗效及安全性

目的:探讨多西紫杉醇与卡铂联合化疗在老年子宫内膜癌患者中的疗效及安全性。方法:选择2010年1月至2016年1月我院收治的子宫内膜癌患者78例作为研究对象,其中年龄60岁的患者42例纳入非老年组,年龄≥60岁的患者36例纳入老年组,均给予多西紫杉醇与卡铂联合化疗。对两组患者一般情况、化疗实施情况、临床疗效以及毒副反应进行观察与比较。结果:两组患者组织学分型有明显差异(P0.05),其他一般资料无显著差别(P0.05)。老年组患者采用低剂量完成化疗的比例明显高于非老年组,差异有统计学意义(P0.05),化疗周期及中断率无显著差异(P0.05)。两组患者临床疗效、血液系统毒副反应及消化系统毒副反应发生率均差异不显著(P0.05)。结论:多西紫杉醇与卡铂联合化疗在老年子宫内膜癌患者中治疗效果与非老年患者类似,安全性尚可,值得临床推广应用。     

子宫内膜癌组织中GDF-15和p-mTOR蛋白的表达及临床意义

目的:研究子宫内膜癌组织中生长分化因子15(GDF-15)和磷酸化哺乳动物雷帕霉素靶蛋白(p-mTOR)的表达,并分析其临床意义,为临床治疗提供依据。方法:选取2011年1月到2016年2月我院子宫内膜癌组织75例为研究组,另选取同期正常子宫内膜组织75例为对照组,应用免疫组化法检测GDF-15和p-mTOR蛋白的表达。结果:研究组GDF-15和p-mTOR蛋白的表达阳性率显著高于对照组,比较差异具有统计学意义(P0.05);子宫内膜癌分期Ⅲ-Ⅳ期、淋巴结转移者、病理分级G2+G3、肌层浸润深度≥1/2的GDF-15和p-mTOR蛋白的表达阳性率均较高(P0.05);子宫内膜癌组织GDF-15与p-mTOR蛋白表达呈正相关关系(P0.05)。结论:子宫内膜癌组织中GDF-15与p-mTOR蛋白表达升高,且与肿瘤转移、临床分期、肌层浸润深度有关。     

IGFBP-1 inhibits EGF mitogenic activity in cultured endometrial stromal cells

The properties of the insulin-like growth factor-binding proteins (IGFBP-1 to 6) are not limited to modulation of IGF actions. IGFBP-1, which shares an Arg-Gly-Asp (RGD) motif in its C-terminal domain, modulates cell motility by binding to integrin alpha5beta1. The cross-talks between integrins and growth factor receptor signalling pathways are extensively documented, particularly in the case of the epidermal growth factor receptor (EGFR). However, whether IGFBP-1 can modulate growth factor signalling through its interaction with integrin alpha5beta1 has not yet been studied. As EGF is involved in the decidualisation of endometrial stromal cells (ESCs) and as decidualised ESCs are a source of IGFBP-1, we investigated if IGFBP-1 can modulate EGF effects on ESCs. RGD- and IGF-independent inhibition of EGF mitogenic activity and EGFR signalling by IGFBP-1 were demonstrated in ESC primary cultures, A431, cells and in mouse fibroblasts lacking IGF receptors.     

Aromatase and comparative response to its inhibitors in two types of endometrial cancer

Aromatase activity (AA) was evaluated totally in 80 tumors collected from primary endometrial cancer (EC) patients. All patients were divided into cases belonging to the types I or II of EC (respectively, 50 and 30 observations). Samples of malignant endometrium from type II demonstrated inclination to the higher AA in comparison with type I samples; the difference reached level of statistical significance in non-smoking patients (p = 0.02). Although no positive correlation was revealed between AA in EC tissue and percentage of cells with DNA damage in normal endometrium from the same patients, the rate of DNA damage (percent of comets, comet's tail average length, etc.) was higher in intact endometrium collected from patients with type II of the disease. In 19 tumor samples, CYP19 gene expression was evaluated by RT-PCR and level of mRNA signal demonstrated positive correlation with AA (R_s = +0.63, p = 0.05) in the whole this material. Of note, though, CYP19 mRNA expression was not revealed in six cases, and all of them belonged to the type I of disease. Finally, in 23 EC patients (15 with type I and 8 with type II of the disease) effects of 2 weeks treatment with letrozole (10 pts) and exemestane (13 pts) were evaluated in neoadjuvant setting. Although diminishing of endometrial M-echo signal and the increases in FSH and LH concentration after treatment were more pronounced in type I patients, decrease in tumor PR content (p = 0.04) was more revealing in patients with type II of EC; besides, the decreases in AA in tumor tissue by the end of treatment were noted predominantly in patients with lower body weight (BMI <27.5). Thus, although type II of EC is frequently considered as hormone-independent, increased ability of this type of the tumor to estrogen biosynthesis (at CYP19 gene and protein level) may lead to the reconsideration of such conclusion and warrants further investigation. The search of possible ethnic differences in AA and in the biologic response to aromatase inhibitors in EC can be of importance too.     

Apport de la TEMP/TDM pour la détection du ganglion sentinelle dans les cancers du col utérin et de l’endomètre

The sentinel lymph node procedure is still under evaluation for the management of cervical and endometrial carcinomas. The aim of our study was to determine the diagnostic accuracy of single-photon emission computed tomography/computed tomography (SPECT/CT) for preoperative sentinel lymph node mapping in uterine cancers. Sixty-eight patients with cervical (n = 42) or endometrial carcinoma (n = 26) underwent preoperative lymphoscintigraphy for sentinel node mapping. Sentinel node detection rate with conventional planar imaging was similar to that of SPECT/CT (87.1 versus 91.8 %) in the whole cohort. However, SPECT/CT detected a higher number of sentinel nodes in more than one third of patients, affected by either cervical or endometrial carcinoma. The rate of non or insufficiently contributive procedures (lack of uptake or unilateral uptake) in endometrial carcinomas was 47 % with conventional planar imaging, and 30 % with SPECT/CT. Sensitivity of both procedures for the detection of metastatic nodes was 81.8 %, compared to 100 % for the intraoperative combined detection (gamma probe sonde and blue dye). The impact of SPECT/CT for the sentinel lymph node detection in cervical and endometrial carcinomas needs further evaluation. Nevertheless, SPECT/CT may provide additional information when conventional planar imaging detects only unilateral uptake, may improve identification of atypical localizations, and facilitate surgical approach.     

AKT 途径在雌激素调控子宫内膜癌KLE 细胞中乙二醛酶Ⅰ 表达的作用

目的:探讨雌激素是否通过AKT途径调控子宫内膜癌KLE细胞中乙二醛酶Ⅰ(GlyoxalaseⅠ,GloⅠ)的表达。方法:采用RT-PCR和Western blotting检测雌激素(17-β雌二醇)处理或AKT途径抑制剂(LY294002)处理子宫内膜癌KLE细胞后GloⅠ的mRNA或蛋白的表达情况。实验分4组:Con组(对照组);LY294002组(LY294002处理组);E2组(17-β雌二醇处理组);E2+LY294002组(LY294002预处理1小时后再17-β雌二醇处理组)。结果:1、经不同浓度的17-β雌二醇(Con、10-11、10-10、10-9M)作用于KLE细胞24小时后,GloⅠmRNA的相对表达量分别为1,1.58±0.04,1.82±0.03,1.81±0.04,以10-10 M的浓度时最为显著(P<0.05)。以10-10 M的17-β雌二醇作用于KLE细胞48小时后,GloⅠ蛋白的相对表达量为1.79±0.02,高于Con组。2、以LY294002抑制AKT途径后,KLE细胞中GloⅠmRNA的相对表达量为0.69±0.03,蛋白的相对表达量为0.16±0.02,均低于Con组。3、E2+LY294002组GloⅠmRNA和蛋白的相对表达量分别为1.02±0.04、1.01±0.03,均低于E2组中GloⅠmRNA和蛋白的相对表达量,E2组分别为1.34±0.03、1.79±0.02。LY294002组GloⅠmRNA和蛋白的相对表达量分别为0.69±0.03,0.16±0.02,均低于Con组GloⅠmRNA和蛋白的相对表达量。结论:雌激素可上调子宫内膜癌KLE细胞中GloⅠmRNA和蛋白的表达。抑制AKT途径可下调子宫内膜癌KLE细胞中GloⅠmRNA和蛋白的表达。AKT途径在雌激素调控子宫内膜癌KLE细胞中GloⅠ的表达无明显作用。     

CXCR4和NF-κB在子宫内膜癌中的表达及其临床意义

目的:检测CXCR4和NF-κB在子宫内膜癌中的表达并探讨其在肿瘤发生发展中的作用机制。方法:用免疫组织化学SP法测定不同子宫内膜组织中CXCR4和NF-κB的蛋白质表达情况,并分析两者表达的相关性,所选标本包括20例正常子宫内膜蜡块、30例子宫内膜不典型增生石蜡标本、60例子宫内膜癌。结果:CXCR4的阳性表达率在子宫内膜癌中为73.33%、在不典型增生子宫内膜中为43.33%,在正常子宫内膜中为25.00%;NF-κB在子宫内膜癌、不典型增生子宫内膜和正常子宫内膜的阳性表达率依次为:63.33%、36.67%、15.00%,差异均具有统计学意义(P0.05)。CXCR4和NF-κB两个因子与淋巴结有无转移、年龄、肌层浸润情况无相关性,但与癌组织分化级别相关。两个因子在子宫内膜癌中的表达具有明显的相关性(r=0.341,P=0.008)。结论:CXCR4和NF-κB在子宫内膜癌组中的阳性表达率明显升高,且两者成正相关,两个因子在诱发子宫内膜癌的发生中可能起协同作用。     

GnRHR-Ⅱ在子宫内膜的分布及表达变化规律研究

目的:研究促性腺激素释放激素Ⅱ型受体(GnRHR-Ⅱ)在子宫内膜的分布及表达变化规律。方法:选择2015年1月~2016年7月期间我院收治的100例女性不孕患者,经诊断性刮宫技术获取50例增生期子宫内膜组织与50例分泌期子宫内膜组织,分别作为研究组与对照组;采用免疫组织化学染色法检测两组子宫内膜基质细胞与腺上皮GnRHR-Ⅱ的表达。结果:增生期、分泌期子宫内膜均有GnRHR-Ⅱ分布;研究组子宫内膜基质细胞的GnRHR-Ⅱ表达明显高于对照组,而腺上皮则明显低于对照组,差异有统计学意义(P0.05)。结论:GnRHR-Ⅱ在子宫内膜增生期与分泌期均有表达,且在膜基质细胞与腺上皮均有分布,其分布于表达变化规律在一定程度上与子宫内膜容受性有关,有望成为评估子宫内膜容受性的标记物。     

子宫内膜癌组织miR-155、miR-202表达与增殖侵袭基因表达、临床病理参数和预后的关系

摘要 目的：探讨子宫内膜癌（EC）组织中微小核糖核酸-155（miR-155）、微小核糖核酸-202（miR-202）表达情况与增殖侵袭基因表达、临床病理参数和预后的关系。方法：选择2015年10月至2018年10月在本院进行手术治疗的EC患者135例为观察组,另选择同期因子宫肌瘤行全子宫切除术的患者135例为对照组,采用实时荧光定量聚合酶链式反应（RT-qPCR）检测并比较两组miR-155、miR-202及增殖基因（Cdk4、Cdk6、Efemp2、DJ-1、RRM2）、侵袭基因（Dkk1、Ezh2、HMGB1）表达情况,分析EC组织miR-155、miR-202表达与患者临床病理参数的关系。采用Kaplan-Meier生存曲线分析miR-155、miR-202高表达组与低表达组的5年累积生存率。结果：观察组miR-155、Ezh2、HMGB1、Cdk4、Cdk6、DJ-1、RRM2相对表达量高于对照组,miR-202、Dkk1、Efemp2相对表达量低于对照组（P＜0.05）。miR-155的相对表达量与Cdk4、Cdk6、DJ-1、RRM2、Ezh2、HMGB1呈正相关,与Efemp2、Dkk1呈负相关（P＜0.05）;miR-202相对表达量与Efemp2、Dkk1呈正相关,与Cdk4、Cdk6、DJ-1、RRM2、Ezh2、HMGB1呈负相关（P＜0.05）。EC患者肿瘤FIGO分期越高、分化程度越低、肌层浸润越深及有淋巴结转移患者miR-155的相对表达量越高,miR-202的相对表达量越低（P＜0.05）。高miR-155组5年总生存率为68.66%,低于低miR-155组的87.50%（P＜0.05）;高miR-202组5年生存率为91.80%,高于低miR-202组的65.71%（P＜0.05）。结论：EC组织中miR-155表达升高,miR-202表达降低,与增殖侵袭基因表达、FIGO分期、分化程度、肌层浸润深度及有淋巴结转移有明显的相关性,miR-155表达越高、miR-202表达越低,患者预后越差。